Since late February of 2020, the country has dealt with the Covid-19 pandemic, and we have seen multiple coding changes occur over the previous months. As the pandemic continues to surge around the country, we see coding changes that have been sparked by the healthcare response to the pandemic.
Earlier in the year, the CPT code 99072 was added and approved as a way to help reduce the spread of the coronavirus while ensuring that patients still had access to quality, safe care when interacting with health care professionals. The additional clinical staff time and supplies required to perform essential safety protocols as described in the code allowed for the evaluation, treatment, and/or procedural services during this health emergency while working to ensure the health and safety of both health care professionals and patients.
Next, the CPT code 86413 was added and approved to cover the laboratory tests offering measurements of SARS-CoV-2 antibodies instead of a positive/negative result that was reported by various other CPT codes. With the new code, tests reporting using code 86413 can take a look at the patient’s adaptive immune response to Covid-19, determining the effectiveness against treatments that have been used to treat the infection.
2021 New ICD-10 Codes
For 2021, CMS has introduced 21 new procedure codes for Covid-19 therapeutics and vaccines to treat the coronavirus, including monoclonal antibody and baricitinib treatments. Recently, the FDA approved the use of the rheumatoid arthritis drug baricitinib (brand name Olumiant) to treat Covid-19 along with remdesivir for hospitalized patients. With the new ICD-10 2021 codes, healthcare providers can document using this drug, along with the administration of Covid-19 vaccines, including monoclonal antibodies and immunomodulatory and second injections that have been approved.
Medicare Severity Diagnosis Related Groups (MS-DRGs) were assigned by CMS to six of the new diagnosis codes for conditions that are related to the virus. Codes that have been given MS-DRGs include those for:
- Encounter for Covid-19 screening
- Personal history of Covid-19
- Pneumonia that is due to Covid-19
- Other systemic involvement of connective tissue
- Suspected Covid-19 exposure
- Multisystem inflammatory syndrome
According to CMS, Medicare will not only pay for Covid-19 vaccines but also for the administration of those vaccines separately. Providers are to be paid $28.39 for a single-dose Covid-19 vaccine administration. If a vaccine approved for the virus requires multiple doses, then $16.94 will be reimbursed to providers for the first disease and $28.39 for the final dose to be administered.
Providers can bill the Covid-19 vaccine on single claims for the administration of shots, or they may submit claims on a roster bill, taking care of multiple patients at one time. However, to use the roster bill (if not an inpatient hospital), providers will need to administer the Covid-19 vaccine to a minimum of five patients in one day.
Additional Covid-19 Updates for 2021
Of note for 2021 is the instruction to use only U07.1 for confirmed cases of Covid-19. Guidelines now require that only confirmed cases of the virus are coded using this code and must be documented with a positive Covid-19 test result. If healthcare providers only feel like the virus is possible or suspected, this code should not be used, and the symptoms and signs the patient is experiencing should be reported instead.
The sequencing of codes is also important. If Covid-19 is the principle diagnosis and code U07.1 is used, it should be sequenced first unless there’s another guideline requiring that another code is used first, such as transplant, obstetrics, or sepsis complications.
When dealing with acute respiratory manifestations of the novel coronavirus, if the respiratory manifestation of the virus is the reason for the encounter, the Covid-19 code U07.1 should be used as the first-listed diagnosis, but then respiratory manifestation codes should be added as additional diagnoses. A few examples include:
- Acute bronchitis that’s been confirmed as a result of Covid-19 – Covid U07.1, J40
- Pneumonia that’s confirmed a result of Covid-19 – Covid U07.1, J12.89
- Covid-19 that’s been documented as linked with a respiratory infection – NOS U07.1, J98.8
When coding for exposure for Covid-19, the code Z20.828 should be used for asymptomatic patients who have suspected or actual exposure to the virus. If the patients are symptomatic with suspected or actual exposure to Covid-19 and test results are unknown, or infection has been ruled out, you’ll also use Z20.828. For patients that have the signs and symptoms associated with the virus (i.e., fever) but there’s not a definitive diagnosis. Appropriate codes should be assigned for the presenting symptoms and signs.
Additional codes include:
- Z86.19 – for patients that have a history of Covid-19
- Z01.84 – encounter for antibody testing not conducted to confirm current infection with Covid-19 or a follow-up test after Covid-19 resolution.
While 2021 comes with a significant number of billing and coding changes, including the E&M and Covid-19 coding changes, we’re here to help you navigate the new year. At M-Scribe.com, we specialize in medical billing and coding, helping practices across the country navigate the updates while improving their bottom line. Learn more about how we can help your practice in 2021. Contact M-Scribe.com today at 770-666-0470.